Most Diabetes Apps Do Not Provide Real Time Decision Support (yet)

MedicalResearch.com Interview with:

Associate Professor Josip CarMD, PhD, DIC, MSc, FFPH, FRCP (Edin)​Associate Professor of Health Services Outcomes Research,​Director, Health Services Outcomes Research Programme and DirectorCentre for Population Health SciencesPrincipal Investigator, Population Health & Living Laboratory

Prof. Car

Associate Professor Josip Car
MD, PhD, DIC, MSc, FFPH, FRCP (Edin)​
Associate Professor of Health Services Outcomes Research,​
Director, Health Services Outcomes Research Programme and Director
Centre for Population Health Sciences
Principal Investigator, Population Health & Living Laboratory 

MedicalResearch.com: What is the background for this study?

Response: In 2018, almost 8% of people with diabetes who owned a smartphone used a diabetes app to support self-management. Currently, most apps are not regulated by the US Food and Drug Administration (FDA). We downloaded and assessed 371 diabetes self-management apps, to see if they provided evidence-based decision support and patient education.  Continue reading

Suboptimal Physical Activity in Women Associated With Increased Healthcare Spending

MedicalResearch.com Interview with:
Erin D. Michos, MD, MHS, FACC, FAHA, FASE
Associate Professor of Medicine and Epidemiology
Associate Director of Preventive Cardiology
Ciccarone Center for the Prevention of Heart Disease
Johns Hopkins School of Medicine

Victor Okunrintemi, MD, MPH
Department of Internal Medicine
East Carolina University
Greenville, North Carolina 

MedicalResearch.com: What is the background for this study?  

Response: Women are less physically active than men on average, and the lack of regular physical activity has been associated with increased risk of cardiovascular disease and poorer health outcomes. Although recommendations encouraging regular physical activity has been in place for decades, we do not know how much of these recommendations are met, particularly among high risk women with established cardiovascular disease for secondary prevention.

This study was therefore designed with the aim of describing the 10-year trends for the proportion of women with cardiovascular disease who do not meet these recommend physical activity levels, overall and by key sociodemographic groups, and the associated cost implications.

Continue reading

Epilepsy: Genetic Testing Should Include Parental Sampling

MedicalResearch.com Interview with:

Dr. Ahmad Abou Tayoun, PhDClinical Molecular GeneticistDirector of the Genetics LaboratoryAl Jalila Children’sUnited Arab Emirates

Dr. Abou Tayoun

Dr. Ahmad Abou Tayoun, PhD
Clinical Molecular Geneticist
Director of the Genetics Laboratory
Al Jalila Children’s
United Arab Emirates

MedicalResearch.com: What is the background for this study?  

Response: In this study, we provide data in favor of using an exome-based testing approach, where parental samples can be readily accessible, for early onset epilepsy patients. The exome test includes all coding genes in the human genome. Although we perform exome sequencing on those patients, we demonstrate that a first tier analysis should include targeted interpretation of ~100 genes strongly associated with the disease. This analysis provides diagnoses in ~11% of the patients. Follow up parental testing on a limited number of patients (n=15) that had inconclusive results, revealed de novo (new mutations) variant status, leading to upgrade to positive reports in 7 patients and adding ~5% to the overall diagnostic yield.

Continue reading

Is There a Link Between Benzodiazepines During Pregnancy and Childhood ADHD?

MedicalResearch.com Interview with:

Dr. Angela Lupattelli, PhDSchool of PharmacyUniversity of Oslo

Dr. Lupattelli

Dr. Angela Lupattelli, PhD
School of Pharmacy
University of Oslo

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Between 1-4% of pregnant women take at least once a benzodiazepine and/or a z-hypnotic medication during the course of gestation. These medications are generally used intermittently in pregnancy, mainly for treatment of anxiety disorders and sleeping problems, which are not uncommon conditions among pregnant women.

However, data regarding the safety of benzodiazepine and/or a z-hypnotic in pregnancy on child longer-term development are sparse. For instance, studies on child motor skills are only available up to toddler age, and little is known in relation to other child developmental domains. So, there is an urgent need to better understand whether prenatal use of benzodiazepine and/or a z-hypnotic medication may pose detrimental longer-term child risks. Continue reading

Integrated Approach to Laboratory Measurements to Identify Acute Kidney Diseases

MedicalResearch.com Interview with:

Matthew T James MD, PhDAssistant ProfessorUniversity of Calgary

Dr. James

Matthew T James MD, PhD
Assistant Professor
University of Calgary 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The Acute Kidney Disease and Disorders (AKD) criteria from the KDIGO Acute Kidney Injury guidelines identified many patients who do not meet existing criteria for Chronic Kidney Disease or Acute Kidney Injury (AKI), and the majority of AKD events occured in the community rather than hospital setting.

This study characterized the frequency and outcome for patients with AKD (without  AKI) as well as AKD with CKD from among over 1.1 million adults  residing in Alberta Canada who received  kidney function testing and were followed for up to 8 years.

Continue reading

Study finds Value-Based Payment Program Did Not Harm African-American Patients In Terms of Mortality. 

MedicalResearch.com Interview with:

Teryl K. Nuckols, MDVice Chair, Clinical ResearchDirector, Division of General Internal MedicineCedars-Sinai Medical Center 

Dr. Nuckols

Teryl K. Nuckols, MD
Vice Chair, Clinical Research
Director, Division of General Internal Medicine
Cedars-Sinai Medical Center 

MedicalResearch.com: What is the background for this study?  

Response: Healthcare policymakers have long worried that value-based payment programs unfairly penalize hospitals treating many African-American patients, which could worsen health outcomes for this group.

For example, policy experts have suspected that the Medicare Hospital Readmission Reduction Program unevenly punishes institutions caring for more vulnerable populations, including racial minorities. They’ve also feared that hospitals might be incentivized to not give patients the care they need to avoid readmissions.

The study Investigators wanted to determine whether death rates following discharges increased among African-American and white patients 65 years and older after the Medicare Hospital Readmission Reduction Program started.

Continue reading

Extremely Low Gestational Age Neonates May Benefit From Delayed Cord Clamping

MedicalResearch.com Interview with:

Abhay K Lodha Department of PediatricsAlberta Health Services 

Dr. Lodha

Abhay K Lodha MD, DM, MSc
Department of Pediatrics
Alberta Health Services  

MedicalResearch.com: What is the background for this study?

Response: There is no physiological rationale for clamping the umbilical cord immediately after birth. In moderate (32+0 weeks-33+6 weeks) and late preterm infants (34+0 to 36+6), delayed cord clamping reduces the need for blood transfusions, leads to circulatory stability and improves blood pressure.

However, the information on the association of delayed cord clamping with outcomes for extremely low gestational age neonates (22-28 weeks of gestation) is limited.

Continue reading

Americans Increasingly Recognize e-Cigarettes are As or More Harmful than Cigarettes

MedicalResearch.com Interview with:
Jidong Huang, PhD
Associate Professor
Department of Health Policy & Behavioral Sciences
School of Public Health, Georgia State University
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study?  

Response: The US tobacco market has been transformed in the past decade by a rapid increase in awareness and use of e-cigarettes among youth and adults.

This transformation has been accelerated in recent years by the emergence of new generations of e-cigarettes, such as JUUL e-cigarettes. The exponential growth in e-cigarettes has prompted a renewed interest in the tobacco harm reduction approach, which aims to rapidly curbing the smoking epidemic by encouraging smokers to switch to low risk tobacco products, such as e-cigarettes. There is an ongoing debate about whether the scientific evidence on the health risks of e-cigarettes in comparison with combustible cigarettes has been accurately communicated to the public. Large representative surveys are needed to examine how the public perceives the health risk of e-cigarettes and how their perception change over time.

Continue reading

Synthetic Opioids Are Primary Driver of Current Opioid Epidemic

MedicalResearch.com Interview with:

Dr-Mathew Vinhhoa Kiang

Dr. Kiang

Mathew Vinhhoa Kiang, PhD
Postdoctoral Research Fellow
Primary Care and Outcomes Research
Stanford University School of Medicine
Stanford, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nationally, opioid-related mortality has continued to climb for decades and resulted in over 42,000 deaths in 2016 — more than the number of deaths from car accidents or firearms. However, there are substantial differences across states and by opioid type. We sought to systematically describe these differences by examining state-level opioid mortality by opioid type. Deaths from synthetic opioids, such as fentanyl, are rapidly increasing in the eastern half of the US. Specifically, 28 states have synthetic opioid mortality rates that are more than doubling every two years. Twelve of those states already have high levels of synthetic opioid mortality — above 10 deaths per 100,000. Lastly, the opioid epidemic has reached our nation’s capital — Washington DC has the fastest rate of increase, more than tripling every year, and a high opioid mortality rate.

Continue reading

Tai Ji Quan Effective in Reducing Injurious Falls

MedicalResearch.com Interview with:

Fuzhong Li, Ph.D. Senior Scientist Oregon Research Institute

Dr. Li

Fuzhong Li, Ph.D.
Senior Scientist
Oregon Research Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Injurious falls among community-dwelling older adults are a serious public health and cost-bearing problem worldwide.Exercise has been shown to reduce falls and injurious falls among older adults. However, evidence is limited with regard to the type of exercise interventions that are most effective, without exacerbating the risk in some individuals, in reducing injurious falls.

This study addresses this knowledge gap in the field of falls prevention. Findings from this study showed that a six-month Tai Ji Quan program reduced the incidence of injurious falls among frail elderly by 53% compared to a regular (multimodal) exercise intervention. The effect of the Tai Ji Quan intervention was shown to be robust, and still evident at follow-up examinations six months after the study. Continue reading

How Do Physician-Affiliated PACs Vote on Gun Laws?

MedicalResearch.com Interview with:

Hannah Decker

Hannah Decker

Hannah Decker
MD Candidate, Class of 2019
Emory School of Medicine

Jeremiah Schuur, MD, MHS FACEPPhysician-in-chief for emergency medicine at Lifespan and Chair of the department of Emergency Medicine Brown

Dr. Jeremiah Schuur

Jeremiah Schuur, MD, MHS FACEP
Physician-in-chief for emergency medicine at Lifespan and Chair of the department of Emergency Medicine
Brown

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Firearm injury is a leading cause of injury and death in the United States. Many physician groups advocate for evidence-based policies, such as universal background checks, to reduce this morbidity and mortality.

We studied contributions of the 25 largest political action committees (PACs) affiliated with physician professional groups during the 2016 election cycle and found that almost all gave more money to political candidates who voted against universal background checks and were endorsed by the NRA.

These PACs contributed to more than twice as many incumbent US Senate candidates who voted against an amendment to expand firearm background checks than those who voted for the amendment. In the US House of Representatives, the pattern of giving was similar. These PACs gave $2.8 million more to candidates who did not sponsor a bill to expand background checks than to those who did. Finally, these physician PACs were more than twice as likely to contribute to and gave almost $1.5 million dollars more to candidates rated A by the NRA.

Continue reading

Highest NSAID Usage Levels in Working Age Adults Linked to Greater Risk of Kidney Disease

MedicalResearch.com Interview with:
Alan Nelson, MPAS, PhD
Division of Primary Care and Population Health, Department of Medicine
Stanford University School of Medicine
Stanford, California 

MedicalResearch.com: What is the background for this study?  

Response: The past research literature has provided relatively little information on the appropriate level of concern regarding non-steroidal anti-inflammatory drugs (NSAIDs) and kidney disease risk among younger, apparently healthy patients. Clinicians are generally most concerned about the effects of these medications on the kidneys among patients with existing renal impairment and persons at risk for it, especially older patients.

Given that NSAID use appears to be high and rising in the US, we were interested in developing evidence on this topic in a population of working-age adults.

Continue reading

Study Evaluates Thyroid Hormone Suppression For High Risk Thyroid Cancer

MedicalResearch.com Interview with:

Joanna Klubo-Gwiezdzinska, M.D., Ph.D., M.H.Sc. Assistant Clinical Investigator/Assistant Professor Metabolic Disease Branch/NIDDK/NIH Bethesda, MD

Dr. Klubo-Gwiezdzinska

Joanna Klubo-Gwiezdzinska, M.D., Ph.D., M.H.Sc.
Assistant Clinical Investigator/Assistant Professor
Metabolic Disease Branch/NIDDK/NIH
Bethesda, MD

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: People with intermediate- and high-risk differentiated thyroid cancer (DTC) are treated with surgical removal of the thyroid gland and radioactive iodine therapy.  After surgery and initial treatment, the thyroid hormone levothyroxine is used for long-term management not only to replace appropriate physiologic thyroid hormones post-surgery, but also to suppress thyrotropin (TSH) release from the pituitary gland at supraphysiologic doses.

The current recommended American Thyroid Association TSH suppression goal in patients with a high-risk differentiated thyroid cancer presenting with distant metastases is less than 0.1mIU/ml, and between 0.1-0.5 mIU/ml for patients with intermediate-risk DTC presenting with local metastases to the neck lymph nodes. This TSH goal is much lower than physiologic TSH level, which ranges between 0.4-4.1 mIU/ml, depending on the measurement method and person’s age.

TSH suppression is used because some preclinical evidence suggests that TSH can stimulate growth of cancer cells.  However, several preclinical studies show that thyroid hormones may also stimulate cancer growth. In addition, too much levothyroxine, leading to TSH suppression, may cause side effects such as abnormal heart rhythms and decreased bone mass.

In this study, based on a large multicenter database analysis, we found that continuous TSH suppression with levothyroxine was not associated with better progression-free survival and overall survival in patients with either intermediate- and high-risk differentiated thyroid cancer. The patients were followed for an average of 7 years after surgical thyroid cancer removal and radioactive iodine therapy.  Continue reading

Not All Hospital Readmissions Are Preventable but READI Protocol Can Assist in Some Cases

MedicalResearch.com Interview with:

Marianne Weiss DNSc RN READI study Principal Investigator Professor of Nursing and Wheaton Franciscan Healthcare / Sister Rosalie Klein Professor of Women’s Health Marquette University College of Nursing Milwaukee Wi, 53201-1881

Dr. Weiss

Marianne Weiss DNSc RN
READI study Principal Investigator
Professor of Nursing and
Wheaton Franciscan Healthcare / Sister Rosalie Klein Professor of Women’s Health
Marquette University College of Nursing
Milwaukee Wi, 53201-1881

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our team of researchers has been studying the association of patient readiness for discharge and readmission for several years. We have previously documented that patients who had ‘low readiness’ on our Readiness for Hospital Discharge Scale were more likely to be readmitted. In this study we added structured protocols for discharge readiness assessment and nurse actions to usual discharge care practices to determine the optimal protocol configuration to achieve improved post-discharge utilization outcomes.

In our primary analysis that included patients from a broad range of patient diagnoses, we did not find a significant effect on readmission from adding any of the discharge readiness assessment protocols. The patient sample came from Magnet hospitals, known for high quality care, and the average all-cause readmission rates were low (11.3%).

In patients discharged from high-readmission units (>11.3%), one of the protocols was effective in reducing the likelihood of readmission. In this protocol, the nurse obtained the patients self-report of discharge readiness to inform the nurse’s discharge readiness assessment and actions in finalizing preparations for discharge. This patient-informed discharge readiness assessment protocol produced a nearly 2 percentage point reduction in readmissions. Not unexpectedly, in lower readmission settings, we did not see a reduction in readmission; not all readmissions are preventable.

In the last phase of study, we informed nurses of a cut-off score for ‘low readiness’ and added a prescription for nurse action only in cases of ‘low readiness’; this addition to the protocol added burden to the nurses’ daily work and eliminated the beneficial effects, perhaps because it limited the nurse’s attention to only a subset of patients. 

Continue reading

Primary Care Doctor Visit After Discharge Reduced Hospital Readmission Rates

MedicalResearch.com Interview with:
Dr. Dawn Wiest, 7-day pledge after hospital admissionDawn Wiest, PhD
Director, Action Research & Evaluation
Camden Coalition of Healthcare Providers

MedicalResearch.com: What is the background for this study?

Response: Understanding the role of care transitions after hospitalization in reducing avoidable readmissions, the Camden Coalition launched the 7-Day Pledge in 2014 in partnership with primary care practices in Camden, NJ to address patient and provider barriers to timely post-discharge primary care follow-up. To evaluate whether our program was associated with lower hospital readmissions, we used all-payer hospital claims data from five regional health systems. We compared readmissions for patients who had a primary care follow-up within seven days with similar patients who had a later or no follow-up using propensity score matching.

Continue reading

Female Radiation Oncologists Less Likely to Receive Industry Payments

MedicalResearch.com Interview with:

Dr. Ann Raldow MD MPH Assistant Professor Department of Radiation Oncology David Geffen School of Medicine UCLA

Dr. Raldow

Dr. Ann Raldow MD MPH
Assistant Professor
Department of Radiation Oncology
David Geffen School of Medicine
UCLA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Similar to women in other historically male-dominated fields, female radiation oncologists face unique obstacles in achieving many metrics of career success, including equal salary, research funding, and academic promotion. Our study of industry payments found that female radiation oncologists were less likely than their male colleagues to receive payments from industry and that these payments tended to be of smaller monetary value.

Continue reading

VA Wait Times Now Often Shorter Than in Private Sector

MedicalResearch.com Interview with:

David Shulkin, MD Ninth Secretary, U.S. Department of Veterans Affairs Washington, District Of Columbia Shulkin Solutions LLC Gladwyne, Pennsylvania

Dr. Shulkin

David Shulkin, MD
Ninth Secretary, U.S. Department of Veterans Affairs
Washington, District Of Columbia
Shulkin Solutions LLC
Gladwyne, Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: I came to VA in 2015 as Under Secretary for Health, as a result of the 2014 wait time crisis.  At that time, it was determined that in some locations, veterans had been waiting for care for too long and there were allegations that this had resulted in harm to a number of veterans.  I was in the private sector at the time, but was asked by President Obama to come and help improve the situation.

Upon my arrival we created systems to determine which veterans were waiting for urgent healthcare and which ones for routine care.  From here, we established same day services for all veterans waiting for urgent care through primary care and behavioral health access points.  This goal was achieved nationwide at the end of 2016.  When I became Secretary in 2017,  we began publishing our wait time data for all to see, so that veterans had accurate information on which to base their choices on and to provide transparency into where we were improving and where we needed to focus our efforts.  In addition, through programmatic and legislative efforts, we expanded our utilization of private sector options so that veterans with clinical needs would be able to get better access to care.

This study was meant to determine whether our efforts from 2014 had resulted in improvements to access and in addition how access to care in the VA compared to access in the private sector.   Despite limitations in the data available from the private sector (since others do not publish their actual wait time data similar to VA) we used a data set that we felt had some applicability for these comparisons.

We found that for the most part, VA wait times are often shorter than in the private sector,  and that VA wait times had improved since 2014 while the private sectors access had stayed the same.  Continue reading

WHO: Profits Outweigh R&D Costs of New Cancer Drugs

MedicalResearch.com Interview with:

Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland

Dr. Kiu Tay-Teo

Kiu Tay-Teo, PhD
World Health Organization
Geneva, Switzerland

MedicalResearch.com: What are the main findings?

Response: High costs and high risks of R&D for drugs have been presented to justify high drug prices, especially for cancer drugs. However, it is unclear whether prices are in fact justifiable compared to the overall return on R&D investment.

In this paper, we systematically compared incomes from the sales of cancer drugs with the R&D costs. We quantified the incomes generated from the sales of 99 cancer drugs approved by FDA from 1989–2017. This was based on sales figures reported in the originator companies’ annual financial reports, and where necessary, estimates deduced from the reported figures. The sales incomes were net of rebates and discounts, but without accounting for expenses and taxes. For the R&D costs of bringing one new cancer drug to the market, the literature reported a typical costs of between $219 million and $2.9 billion, after accounting for the costs of failed products that were investigated but not marketed and the opportunity costs. For the main analysis, we used a median cost of $794 million, as reported in the literature. To be clear, this analysis did not estimate profit return because we do not have information about the costs and year-to-year variations in costs (i.e. expenses and taxes) specific to cancer drugs.

Continue reading

Less Time in the Womb Linked to Less Education and Income in Adulthood

MedicalResearch.com Interview with
"Pregnancy 1" by operalynn is licensed under CC BY 2.0Josephine Funck Bilsteen, MSc
Department of Pediatrics, Hvidovre University Hospital, Hvidovre,
Section of Epidemiology, Department of Public Health
University of Copenhagen
Copenhagen, Denmark

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The background of this study is that there is increasing recognition of the longer-term health and social outcomes associated with preterm birth such as independent living, quality of life, self-perception and socioeconomic achievements. However, much less is known about differences in education and income among adults born at different gestational weeks in the term period.

In this study shorter gestational duration, even within the term range, was associated with lower chances of having a high personal income and having completed a secondary or tertiary education at age 28 years. This is the first study to show that adults born at 37 and 38 completed weeks of gestation had slightly lower chances of having a high income and educational level than adults born at 40 completed weeks of gestation.  Continue reading

Computer Simulation Study Favors Tomosynthesis over Digital Mammography

MedicalResearch.com Interview with:

Aldo Badano, Ph.D. Deputy Director, Division of Imaging, Diagnostics, and Software Reliability Office of Science and Engineering Laboratories Center for Devices and Radiological Health Silver Spring, MD 20993

Aldo Badano, Ph.D.
Deputy Director, Division of Imaging, Diagnostics, and Software Reliability
Office of Science and Engineering Laboratories
Center for Devices and Radiological Health Silver Spring, MD 20993 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Expensive and lengthy clinical trials can delay regulatory evaluation of innovative technologies, affecting patient access to high-quality medical products. Although computational modeling is increasingly being used in product development, it is rarely at the center of regulatory applications.

Within this context, the VICTRE project attempted to replicate a previously conducted imaging clinical trial using only computational models. The VICTRE trial involved no human subjects and no clinicians. All trial steps were conducted in silico. The fundamental question the article addresses is whether in silico imaging trials are at a mature development stage to play a significant role in the regulatory evaluation of new medical imaging systems. The VICTRE trial consisted of in silico imaging of 2986 virtual patients comparing digital mammography (DM) and digital breast tomosynthesis (DBT) systems.

The improved lesion detection performance favoring DBT for all breast sizes and lesion types was consistent with results from a comparative trial using human patients and radiologists.  Continue reading

Majority of Patients Withhold Important Information From Their Health Care Providers

MedicalResearch.com Interview with:

Dr. Gurmankin Levy

Dr. Andrea Gurmankin Levy, PhD MBE
Department of Social Sciences
Middlesex Community College, Middletown, Connecticut

MedicalResearch.com: What is the background for this study?

Response: It is so important for clinicians to get accurate information from their patients so that they can make accurate diagnoses and appropriate recommendations. But we know that people tend to withhold information from others, and that this is especially true when it comes to sensitive information. And in fact, in medicine, there is a long-standing conventional wisdom that clinicians need to adjust patients’ answers (e.g., doubling patients’ report of alcohol consumption) to get a more accurate picture. So we wanted to explore this. How many patients withhold medically-relevant information from their clinicians, and why do they do so?  There have been surprisingly few studies looking at this question in a comprehensive way.

Continue reading

Chronic Kidney Disease Rate Rising Faster Than Other Noncommunicable Diseases

MedicalResearch.com Interview with:

Dr. Ziyad Al-Aly, MD Associate Chief of Staff for Research and Education Veterans Affairs St. Louis Health Care System

Dr. Al-Aly

Dr. Ziyad Al-Aly, MD
Associate Chief of Staff for Research and Education
Veterans Affairs St. Louis Health Care System
Institute for Public Health
Washington University, St. Louis MO

MedicalResearch.com: What is the background for this study?

Response: A lot has changed in the US over the past 15 years including aging, population growth, and increased exposure to risk factors such as obesity, elevated blood pressure, etc. With all of these changes, we wondered, how did the burden of kidney disease change in the United States over the past 15 years.
Continue reading